Research Database, The University of Dundeehttp://discovery.dundee.ac.uk/portal/en/persons/bruce-guthrie(790fc352-7748-49ec-93aa-71da72a0bf88)/clippings.rss
RSS FeedBetter guidelines needed for multimorbidityhttp://discovery.dundee.ac.uk/portal/en/clippings/better-guidelines-needed-for-multimorbidity(f8f48e41-8e12-4513-8aaf-3d774d6a1fda).html
<div style='font-size: 9px;'><div class="rendering rendering_clipping rendering_short rendering_clipping_short"><h2 class="title"><a class="link" rel="Clipping" href="http://discovery.dundee.ac.uk/portal/en/clippings/better-guidelines-needed-for-multimorbidity(f8f48e41-8e12-4513-8aaf-3d774d6a1fda).html"><span>Better guidelines needed for multimorbidity</span></a></h2><div class="textblock"><span class="date">9/10/12</span></div><ul class="relations persons"><li><a class="link person" rel="Person" href="http://discovery.dundee.ac.uk/portal/en/persons/bruce-guthrie(790fc352-7748-49ec-93aa-71da72a0bf88).html"><span>Bruce Guthrie</span></a></li><li><a class="link person" rel="Person" href="http://discovery.dundee.ac.uk/portal/en/persons/marion-e-t-mcmurdo(89e2893d-e29a-45b4-b4ff-af3a2fbdafd9).html"><span>Marion E. T. McMurdo</span></a></li></ul><p class="type"><span class="type_family">Press clipping<span class="type_family_sep">: </span></span><span class="type_classification">Research</span></p></div><div class="rendering rendering_clipping rendering_detailsportal rendering_clipping_detailsportal"><p><span class="date">9/10/12</span></p><p></p><div class="textblock"><p>New clinical guidelines need to be developed to help doctors provide better care for people with more than one chronic illness, according to a research team led by the University of Dundee.</p>
<p>In an article published in the British Medical Journal, the research team - which includes the Universities of Dundee, Glasgow and Manchester and the National Institute for Health and Clinical Excellence (NICE) - say that existing guidelines which concentrate on individual diseases are not best serving clinicians or patients where a number of chronic conditions have to be treated.</p>
<p>"Doctors and other professionals often use guidelines to inform their clinical decision making, and clinical guidelines have played an important part in making healthcare more consistent, efficient, and systematic," said Professor Bruce Guthrie, of the Medical Research Institute at the University of Dundee.</p>
<p>"Through the National Institute for Health and Clinical Excellence and the Scottish Intercollegiate Guidelines Network (SIGN), the UK is a world leader in guideline methodology, and guideline development and implementation.</p>
<p>"Despite their success, clinical guidelines are almost always focused on making recommendations about the treatment of individual diseases, which can make their use in clinical practice problematic. This is because most people with long term conditions have more than one chronic illness, particularly older people in whom multiple chronic illnesses (multimorbidity) are the norm.</p>
<p>"For example, 93% of people with coronary heart disease (heart attacks or angina) have at least one other chronic condition, and a fifth have five or more other conditions.</p>
<p>"This creates a paradox - every individual guideline recommendation may be rational and strongly evidence based, but the cumulative effect of recommendations for multiple chronic conditions may not be appropriate as recommendations are contradictory or treatments recommended interact, or because the burden imposed on patients in terms of numbers of drugs, non-drug therapies (diet, exercise, physiotherapy and so on), and attendance for investigation or follow-up may be overwhelming and not feasible for some people with multiple conditions.</p>
<p>"There will of course be many situations where all guideline recommendations are non-contradictory and appropriate, but previous studies in the USA have shown that guidelines there only occasionally address multiple conditions and recommendations are frequently inconsistent or would produce undesirable drug interactions if implemented.</p>
<p>"Decision making in this situation is complex for both clinicians and patients, but existing guidelines are not ideal for supporting either in deciding the best course of action because they are disease based."</p>
<p>Working with colleagues at the Universities of Manchester and Glasgow, and NICE, Professor Guthrie is leading a research project to implement a new approach to guideline development to help address these problems, and examine its methodological feasibility.</p>
<p>Professors Katherine Payne and Matt Sutton, from the Centre of Health Economics at The University of Manchester, are leading the economic component of the study.</p>
<p>Professor Payne said: "Economic evidence is often used to inform the development of clinical guidelines to provide decision-makers with information on the relative cost effectiveness of the individual interventions included in the guidelines. This study aims to explore if, and how, it is feasible to generate economic evidence to support the development of clinical guidelines involving multiple interventions for people with multiple chronic conditions."</p>
<p>Professor Guthrie added: "This work is exploratory, but if successful will make guideline recommendations more relevant for people with multimorbidity."</p>
<p>The project follows on from previous research published in The Lancet earlier this year by Professor Guthrie and colleagues which showed that having two or more co-existing conditions is the norm for most people with chronic disease, and although the prevalence increases with age, more than half of all people with multimorbidity are under 65.</p>
<p>That paper claimed that health systems in the UK and other developed countries were not devised to deal with this scenario and must be radically changed to cope.</p></div></div></div>Fri, 26 Oct 2012 17:11:30 GMThttp://discovery.dundee.ac.uk/portal/en/clippings/better-guidelines-needed-for-multimorbidity(f8f48e41-8e12-4513-8aaf-3d774d6a1fda).html2012-10-26T17:11:30ZStudy calls for reviews of psychotropic medicationhttp://discovery.dundee.ac.uk/portal/en/clippings/study-calls-for-reviews-of-psychotropic-medication(fee3f6e7-e40c-460b-8a63-7e499a750f34).html
<div style='font-size: 9px;'><div class="rendering rendering_clipping rendering_short rendering_clipping_short"><h2 class="title"><a class="link" rel="Clipping" href="http://discovery.dundee.ac.uk/portal/en/clippings/study-calls-for-reviews-of-psychotropic-medication(fee3f6e7-e40c-460b-8a63-7e499a750f34).html"><span>Study calls for reviews of psychotropic medication</span></a></h2><div class="textblock"><span class="date">13/09/12</span></div><ul class="relations persons"><li><a class="link person" rel="Person" href="http://discovery.dundee.ac.uk/portal/en/persons/bruce-guthrie(790fc352-7748-49ec-93aa-71da72a0bf88).html"><span>Bruce Guthrie</span></a></li></ul><p class="type"><span class="type_family">Press clipping<span class="type_family_sep">: </span></span><span class="type_classification">Research</span></p></div><div class="rendering rendering_clipping rendering_detailsportal rendering_clipping_detailsportal"><p><span class="date">13/09/12</span></p><p></p><div class="textblock"><p>Regular clinical reviews of psychotropic medication should be established in all care homes to promote safe and effective prescribing to an at-risk population of elderly people, according to a new study by researchers at the University of Dundee and NHS Fife, published today in Age &amp; Ageing, the scientific journal of the British Geriatrics Society.</p>
<p>The use of psychotropic drugs - such as antipsychotics and antidepressants - in older people has long been of concern, particularly among those who are in nursing homes. A recent UK Parliamentary report expressed concern that their `inappropriate use' in care homes was a 'means of controlling patients'. There have also been recommendations that there should be a reduction of use of antipsychotic drugs in older people with dementia across the UK.</p>
<p>The new study shows that approximately 1 in 6 older people receive at least one psychotropic medication in a 2-year period. The figure rises to 2 in 5 among nursing home residents.</p>
<p>However, the study found that the majority of psychotropic drugs used by nursing home residents were started prior to the patient being admitted, and for those who started antipsychotics just prior to admission it was more likely the person would continue to receive the drugs.</p>
<p>"This study presents a complex picture of the prescribing and use of these medicines," said Colin McCowan, Deputy Director of the Health Informatics Centre at the University of Dundee. "Psychotropic drug use is significantly higher in care home residents but they would seem to be initiated primarily before people are admitted.</p>
<p>"This may be evidence against the belief that initiation is largely driven by care home staff to make residents easier or more convenient to manage.</p>
<p>"There may be valid reasons for the initiation of these drugs but prolonged use of psychotropic medication in older people is not recommended and may cause harm. The key issue our study suggests is that there should be systematic medication reviews for patients on these drugs, to highlight drugs that may be discontinued if the reasons for their initial prescription are no longer valid."</p>
<p>The study compared the prescribing of psychotropic medications in Tayside for patients living in care homes to patients living at home. It used data gathered over a two-year period.</p>
<p>Previous research has shown that many of the antipsychotics being prescribed to patients are likely to be having very little beneficial effect, and can be reduced and usually stopped.</p>
<p>Stella Clark, of NHS Fife, said there were some promising signs in prescribing patterns but that national guidance still needed to be developed.</p>
<p>"We have recently seen data for the whole of England which showed a reduction in the prescription of antipsychotics to people with dementia," said Stella.</p>
<p>"This is a really important area of prescribing where changes can be made which will improve patient safety and there is a clear need for national guidance to be developed."</p>
<p><strong>NOTES TO EDITORS</strong></p>
<p>Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life. It is the official scientific journal of the British Geriatrics Society and is published by Oxford University Press.</p>
<p>The British Geriatrics Society (BGS) is a membership association of doctors, nurses, therapists, scientists and others with a particular interest in the care of the frail older person and in promoting better health in old age.</p></div></div></div>Wed, 03 Oct 2012 15:38:03 GMThttp://discovery.dundee.ac.uk/portal/en/clippings/study-calls-for-reviews-of-psychotropic-medication(fee3f6e7-e40c-460b-8a63-7e499a750f34).html2012-10-03T15:38:03Zhttp://www.dundee.ac.uk/pressreleases/2012/september12/psychotropic.htmhttp://discovery.dundee.ac.uk/portal/en/clippings/httpwwwdundeeacukpressreleases2012september12psychotropichtm(1941cf8c-f5d7-4a98-b7f6-d61a277a689f).html
<div style='font-size: 9px;'><div class="rendering rendering_clipping rendering_short rendering_clipping_short"><h2 class="title"><a class="link" rel="Clipping" href="http://discovery.dundee.ac.uk/portal/en/clippings/httpwwwdundeeacukpressreleases2012september12psychotropichtm(1941cf8c-f5d7-4a98-b7f6-d61a277a689f).html"><span>http://www.dundee.ac.uk/pressreleases/2012/september12/psychotropic.htm</span></a></h2><div class="textblock"><span class="date">13/09/12</span>: <span class="dimmed"> (Scotsman newspaper)</span></div><ul class="relations persons"><li><a class="link person" rel="Person" href="http://discovery.dundee.ac.uk/portal/en/persons/bruce-guthrie(790fc352-7748-49ec-93aa-71da72a0bf88).html"><span>Bruce Guthrie</span></a></li></ul><p class="type"><span class="type_family">Press clipping<span class="type_family_sep">: </span></span><span class="type_classification">Research</span></p></div><div class="rendering rendering_clipping rendering_detailsportal rendering_clipping_detailsportal"><p><span class="date">13/09/12</span></p><p></p><div class="textblock"><p>http://www.dundee.ac.uk/pressreleases/2012/september12/psychotropic.htm</p>
<p>13 September 2012<br />Study calls for reviews of psychotropic medication<br /><br />Regular clinical reviews of psychotropic medication should be established in all care homes to promote safe and effective prescribing to an at-risk population of elderly people, according to a new study by researchers at the University of Dundee and NHS Fife, published today in Age &amp; Ageing, the scientific journal of the British Geriatrics Society.<br /><br />The use of psychotropic drugs - such as antipsychotics and antidepressants - in older people has long been of concern, particularly among those who are in nursing homes. A recent UK Parliamentary report expressed concern that their `inappropriate use' in care homes was a 'means of controlling patients'. There have also been recommendations that there should be a reduction of use of antipsychotic drugs in older people with dementia across the UK.<br /><br />The new study shows that approximately 1 in 6 older people receive at least one psychotropic medication in a 2-year period. The figure rises to 2 in 5 among nursing home residents.<br /><br />However, the study found that the majority of psychotropic drugs used by nursing home residents were started prior to the patient being admitted, and for those who started antipsychotics just prior to admission it was more likely the person would continue to receive the drugs.<br /><br />"This study presents a complex picture of the prescribing and use of these medicines," said Colin McCowan, Deputy Director of the Health Informatics Centre at the University of Dundee. "Psychotropic drug use is significantly higher in care home residents but they would seem to be initiated primarily before people are admitted.<br /><br />"This may be evidence against the belief that initiation is largely driven by care home staff to make residents easier or more convenient to manage.<br /><br />"There may be valid reasons for the initiation of these drugs but prolonged use of psychotropic medication in older people is not recommended and may cause harm. The key issue our study suggests is that there should be systematic medication reviews for patients on these drugs, to highlight drugs that may be discontinued if the reasons for their initial prescription are no longer valid."<br /><br />The study compared the prescribing of psychotropic medications in Tayside for patients living in care homes to patients living at home. It used data gathered over a two-year period.<br /><br />Previous research has shown that many of the antipsychotics being prescribed to patients are likely to be having very little beneficial effect, and can be reduced and usually stopped.<br /><br />Stella Clark, of NHS Fife, said there were some promising signs in prescribing patterns but that national guidance still needed to be developed.<br /><br />"We have recently seen data for the whole of England which showed a reduction in the prescription of antipsychotics to people with dementia," said Stella.<br /><br />"This is a really important area of prescribing where changes can be made which will improve patient safety and there is a clear need for national guidance to be developed."<br /><br />NOTES TO EDITORS<br /><br />Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life. It is the official scientific journal of the British Geriatrics Society and is published by Oxford University Press.<br /><br />The British Geriatrics Society (BGS) is a membership association of doctors, nurses, therapists, scientists and others with a particular interest in the care of the frail older person and in promoting better health in old age.<br /><br /><br />For media enquiries contact:<br /> Roddy Isles<br /> Head, Press Office<br /> University of Dundee<br /> Nethergate, Dundee, DD1 4HN<br /> TEL: 01382 384910<br /> E-MAIL: r.isles@dundee.ac.uk <br /> MOBILE: 07800 581902</p></div><h3 class="subheader">References</h3><ul class="relations"><li><p><strong>Study calls for reviews of psychotropic medication</strong></p><p>Scotsman newspaper</p></li></ul></div></div>Fri, 14 Sep 2012 11:40:09 GMThttp://discovery.dundee.ac.uk/portal/en/clippings/httpwwwdundeeacukpressreleases2012september12psychotropichtm(1941cf8c-f5d7-4a98-b7f6-d61a277a689f).html2012-09-14T11:40:09Z60,000 Scots prescribed 'high risk' drugshttp://discovery.dundee.ac.uk/portal/en/clippings/60000-scots-prescribed-high-risk-drugs(be6c466f-a533-48bf-b3ff-a6f84979cb96).html
<div style='font-size: 9px;'><div class="rendering rendering_clipping rendering_short rendering_clipping_short"><h2 class="title"><a class="link" rel="Clipping" href="http://discovery.dundee.ac.uk/portal/en/clippings/60000-scots-prescribed-high-risk-drugs(be6c466f-a533-48bf-b3ff-a6f84979cb96).html"><span>60,000 Scots prescribed 'high risk' drugs</span></a></h2><div class="textblock"><span class="date">22/06/11</span></div><ul class="relations persons"><li><a class="link person" rel="Person" href="http://discovery.dundee.ac.uk/portal/en/persons/bruce-guthrie(790fc352-7748-49ec-93aa-71da72a0bf88).html"><span>Bruce Guthrie</span></a></li></ul><p class="type"><span class="type_family">Press clipping<span class="type_family_sep">: </span></span><span class="type_classification">Research</span></p></div><div class="rendering rendering_clipping rendering_detailsportal rendering_clipping_detailsportal"><p><span class="date">22/06/11</span></p><p></p><div class="textblock"><p><a href="http://www.dundee.ac.uk/pressreleases/2011/june11/highrisk.htm">http://www.dundee.ac.uk/pressreleases/2011/june11/highrisk.htm</a></p>
<p>Around 60,000 patients in Scotland are being prescribed drugs with a high risk of side effects, according to new research carried out at the University of Dundee.</p>
<p>Preventable adverse drug events caused by drugs prescribed in primary care are a frequent cause of hospital admission and death. Underlying health problems and other factors mean some patients are more likely to experience side effects which can be serious and even fatal.</p>
<p>Although General Practitioners often have good reasons to prescribe high risk drugs because there may not be any other option to treat debilitating medical conditions, it has been unclear how commonly this happens or how much it varies across general practices.</p>
<p>Professor Bruce Guthrie and colleagues in the Centre for Primary Care and Population Research at the University of Dundee’s School of Medicine, examined the frequency of high-risk prescribing in primary medical care, and the patient and practice characteristics associated with it.</p>
<p>They analysed prescribing records and other data from 315 Scottish General Practices with 1.76 million registered patients and examined the proportion of patients receiving a high-risk prescription using a composite of 15 individual indicators. These included the use of antipsychotic drugs in people with dementia, prescription of non-steroidal anti-inflammatory drugs like ibuprofen to people with previous stomach ulcers or kidney problems, and prescription of drugs recommended to be avoided in people with heart failure.</p>
<p>The team found that high-risk prescribing is common, with 139,404 out of 1,760,223 (7.9%) registered patients defined as being ‘at risk’ of receiving selected high-risk drug due to their age, pre-existing disease or co-prescription. 19,308 of these at-risk patients had been prescribed at least one high-risk drug in the previous year. Rates of high-risk prescribing varied approximately four fold between general practices even after taking into account differences in the patients registered with them.</p>
<p>This study shows that high-risk prescribing associated with harm can be reliably measured using routine clinical data, that it is relatively common, and that rates of such prescribing vary greatly in different general practices. The resulting paper is published today in the British Medical Journal.</p>
<p>Professor Guthrie says that it is important to recognise that many high-risk prescriptions are appropriate because clinicians and patients are often trying to balance benefit and risk in complex situations where there is no clearly ‘correct’ course of action. However, the big differences between practices indicates that prescribing could be made safer.</p>
<p>'The implications are that our study looked at a sample of about a third of Scottish patients. If you take this across the whole of Scotland, then approximately 60,000 people particularly vulnerable to side effects might be being prescribed high risk drugs. This may be the correct course of action and bring benefits to the patient but it has to be balanced against the dangers.</p>
<p>'We're not saying that all this type of prescribing should not be happening, but that we have to be satisfied that it’s appropriate and ensure that doing so doesn’t put the patient at more risk. All prescribing is risky to some extent, but the drugs we examined are particularly risky in some patients and we have to balance the benefits derived from these drugs and with the risks of taking them.</p>
<p>'We identified those people who, due to their age or medical history, are more likely to experience side effects which can be serious. What we found was that this type of high risk prescribing was fairly common but that it varies a lot between practices, and this variation is largely unexplained. The variation was considerable, with a fourfold difference in high risk prescribing between those practices at either end of the scale.</p>
<p>'We can’t make sweeping statements about people routinely being put at risk because of inappropriate prescribing. We would need to know more about the individual circumstances of the patient, but the fact high risk prescribing varies between practices suggests that there is scope to make prescribing safer.'</p>
<p>The number of chronic drugs is the patient characteristic most associated with high-risk prescribing. Since all the prescribing examined is stated in national guidance to be contra-indicated or to be avoided in routine practice, the report concludes that the high rates and large variation between practices is consistent with there being significant opportunities for improvement.</p>
<p>Although fifteen indicators were examined, feasibility constraints meant that other important indicators could not be examined. Professor Guthrie says the study is therefore likely to under-estimate true rates of high-risk prescribing. The prescribing being measured is high-risk but will sometimes be appropriate, since prescribers and patients often have to make decisions in situations where there is no clearly correct course of action.</p>
<p>'It’s all about improving the quality of prescribing. At the moment, GP practices do not get this kind of information. The feedback they receive about their prescribing is focused on costs, and there is less attention paid to prescribing quality and safety.</p>
<p>'Practices may therefore not be aware they are doing something different from others, and may be surprised to see that they prescribe more high risk drugs than others. We feel it would be helpful to let practices know how they compare to others and think the number of vulnerable patients being prescribed high risk drugs can be reduced.'</p>
<p>The study was funded by NHS Quality Improvement Scotland and Scottish Government Chief Scientist Office. Professor Guthrie says the next stage is to carry out further research into the effectiveness of uniform guidelines to reduce the number of deaths and ill-health caused by high-risk prescribing.</p>
<p>He added, 'We are now recruiting general practices in Tayside and Fife to the DQIP study which will test the effectiveness of providing GP practices with prescribing guidelines and information about their rates of high risk prescribing to try and enhance patient safety.</p>
<p>'In the rest of Scotland, we will be carrying out another study in collaboration with NHS Scotland Information Services Division and University of Strathclyde, which will use new NHS Scotland datasets to feedback prescribing safety data to practices. We believe that these new interventions hold much promise for making prescribing safer.'</p>
<p> </p>
<p>For media enquiries contact:<br />Grant Hill<br />Press Officer<br />University of Dundee<br />Nethergate, Dundee, DD1 4HN<br />TEL: 01382 384768<br />E-MAIL: <a href="mailto:g.hill@dundee.ac.uk">g.hill@dundee.ac.uk</a> <br />MOBILE: 07854 953277</p></div></div></div>Wed, 12 Sep 2012 10:49:15 GMThttp://discovery.dundee.ac.uk/portal/en/clippings/60000-scots-prescribed-high-risk-drugs(be6c466f-a533-48bf-b3ff-a6f84979cb96).html2012-09-12T10:49:15ZNew research on multiple medical conditionshttp://discovery.dundee.ac.uk/portal/en/clippings/new-research-on-multiple-medical-conditions(1ea32cbd-0428-4e58-8235-1eb0f4c17489).html
<div style='font-size: 9px;'><div class="rendering rendering_clipping rendering_short rendering_clipping_short"><h2 class="title"><a class="link" rel="Clipping" href="http://discovery.dundee.ac.uk/portal/en/clippings/new-research-on-multiple-medical-conditions(1ea32cbd-0428-4e58-8235-1eb0f4c17489).html"><span>New research on multiple medical conditions</span></a></h2><div class="textblock"><span class="date">18/05/12</span></div><ul class="relations persons"><li><a class="link person" rel="Person" href="http://discovery.dundee.ac.uk/portal/en/persons/bruce-guthrie(790fc352-7748-49ec-93aa-71da72a0bf88).html"><span>Bruce Guthrie</span></a></li></ul><p class="type"><span class="type_family">Press clipping<span class="type_family_sep">: </span></span><span class="type_classification">Research</span></p></div><div class="rendering rendering_clipping rendering_detailsportal rendering_clipping_detailsportal"><p><span class="date">18/05/12</span></p><p></p><div class="textblock"><p>New research showing that having several medical conditions is not just a feature of old age has been published online in The Lancet. <br /><br />The study, which was funded by the Scottish Government Chief Scientist Office, was led by Bruce Guthrie, Professor of Primary Care Medicine at the School of Medicine and colleagues here and at Glasgow University.</p>
<p>It involved taking a snapshot of data on 40 common chronic conditions from a database of 1.75 million people registered with 314 medical practices in Scotland. For each of the 40 conditions, people with only that condition were a minority.<br /><br />The research team found that around 2 in 5 patients (42%) had one or more conditions, and almost a quarter (23%) had 2 or more and thus had multimorbidity. Although the prevalence of multimorbidity increased substantially with age and was present in most people aged over 65, the absolute number of people with multimorbidity was higher in those under 65.<br /><br />Importantly, the onset of multimorbidity occurred 10-15 years earlier in people living in the most deprived areas compared with the most affluent, with socioeconomic deprivation particularly associated with the combination of physical and mental health disorders.<br /><br />The risk of having a mental health disorder increased as the number of physical morbidities increased. Those with five or more physical conditions were around four times more likely to have a co-existing mental disorder while those in deprived areas were twice as likely to have a co-existing mental disorder as those in affluent areas.<br /><br />"Our findings challenge the single-disease framework by which most health care, medical research, and medical education is configured,” the authors said. “Existing approaches need to be complemented by support for the work of generalists, mainly but not exclusively in primary care, providing continuity, coordination, and above all a personal approach for people with multimorbidity.<br /><br />“To avoid widening inequality, this approach is most needed in socioeconomically deprived areas, where multimorbidity happens earlier, is more common, and more frequently includes physical-mental health comorbidity.”</p></div></div></div>Tue, 22 May 2012 08:27:12 GMThttp://discovery.dundee.ac.uk/portal/en/clippings/new-research-on-multiple-medical-conditions(1ea32cbd-0428-4e58-8235-1eb0f4c17489).html2012-05-22T08:27:12Z